Medicaid and children: some recent lessons and reasonable next steps

This article analyzes the recent federal experience in subsidizing health care services for low-income children. The overall equalizing effects of Medicaid are discussed, as are those of Medicaid's component that promotes preventive services for children, the Early and Periodic Screening, Diagnosis, and Treatment program (EPSDT). Both Medicaid and EPSDT have provided poor children greater access to services, but, due to their insurance-based approach, have been unable to resolve structural inequities inherent in the present health care delivery system. The Comprehensive Health Assessment Plan (CHAP), a recent Administration proposal to revise and expand EPSDT, is also discussed and characterized as providing some improvement but retaining the underlying limitations of EPSDT. Four alternatives are proposed that could complement CHAP at limited additional cost.